DIRECT Pathway Questions

[TUGM]

I know the DIRECT pathway has been discussed before on these forums. I'm applying to radiology residency in 2014. Wondering if anyone has any advice on DIRECT pathway applications?

2 years of clinical, 27 months of diagnostics, and 21? months of IR... after this can you still complete a Neurorads-->NIR fellowship and potentially do head-to-toe IR? I've heard (probably from this site) that practices look down on DIRECT pathway graduates when it comes to getting a job?

I'm sure Shark has some insight..

Thanks everyone!

---

Members don't see this ad.

 

[shark2000]

You can apply for Neurorad and NeuroIR, unless things change dramatically.

This makes it 9 years of post grad education.

If you have IR CAQ and Neuro CAQ and NeuroIR skills, you will be very markatable, if you are flexible. I mean you may have to compromise to some extent. Expect to do some DR and some diagnostic Neuro. You may not end up doing a lot of NeuroIR.

If you are direct pathway, many groups see you as a weak diagnostic radiologist. However, after doing Neuro fellowship you will be fine, IMO. Direct pathway is ranked lower if you are applying for a pure diagnostic fellowship like dignostic Neuro or MSK. However, as far as I know, NeuroIR programs love IR trained candidates.

Radiology has a lot of opportunities, if you have flexibility. If you are very focused on certain aspect of it, you will be disappointed. And this is not specific to radiology. However, if you are happy doing diagnostics or IR or NeuroIR and don't mind not doing some of those, you will be fine.

 

[TUGM]

Are DIRECT Pathway positions more competitive than Diagnostic?

 

[shark2000]

Are DIRECT Pathway positions more competitive than Diagnostic?

Less competetive.

No matter what IR people say, the only reason IR is a competetive fellowship these days is the job market. Most of these people who apply for IR fellowship, would apply for other fields if it were not because of market pressure.

The same for breast imaging. 6 years ago they were begging for applicants. I think there was an article in radiographics which showed only half of their spots filled and then in two years the number of applicants tripled. IR was in the same boat.

If I wanted to go to a surgical field, I would pick something else. My 2 cents.

 

[badasshairday]

Less competetive.

No matter what IR people say, the only reason IR is a competetive fellowship these days is the job market. Most of these people who apply for IR fellowship, would apply for other fields if it were not because of market pressure.

The same for breast imaging. 6 years ago they were begging for applicants. I think there was an article in radiographics which showed only half of their spots filled and then in two years the number of applicants tripled. IR was in the same boat.

If I wanted to go to a surgical field, I would pick something else. My 2 cents.

I also think part of the reason IR wasn't popular in the past because the lifestyle was much worse than diagnostics alone. Why work more hours for the same amount of money, was the thought in the past. I know most radiology residents and attenings now have all liked IR, but didn't want to give up the "radiology lifestyle".

 

[DrMasochist]

There are only like 4 DIRECT programs now since many have closed them down while they wait for the new dual IR/DR certificate.

UVA-- 2 spots
Christiana Care-- 1 spot
UPENN--- 2 spots
Arkansas-- 1 spot

Most places allow you to do mini fellowships during your 4th year. Check the thread on this forum which has a spreadsheet of the programs. I think NZIMM posted it awhile ago. Also check the other threads for more info.

 

[SIRStudents]

Here's the link to the most current list of both DIRECT and Clinical Pathway programs as well as other programs that are heavy in IR.

https://docs.google.com/spreadsheet/ccc?key=0Ap-jzNRSzc2XdGJES3gxU2MtRURZRDZrN1VzNXAtWkE#gid=0

Hope this helps!

 

[TUGM]

Thanks for the input and links, guys!

 

[tco]

Thought I'd post this here...

How does one choose the proper residency situation for IR? I've heard the argument both ways...You can go to a place that doesn't have fellowship so you can be more involved, or you can go somewhere with a fellowship to stay there and train when you're done.

Looking at that list, somewhere like Baylor has 12 (!!!!) IR attendings, but no fellowship program. Would this be a good place to train to get optimum experience, or would somewhere like UVA be the better bet with a good clinical background and proven IR fellowship?

Thanks.

 

[TheRealDrDorian]

Thought I'd post this here...

How does one choose the proper residency situation for IR? I've heard the argument both ways...You can go to a place that doesn't have fellowship so you can be more involved, or you can go somewhere with a fellowship to stay there and train when you're done.

Looking at that list, somewhere like Baylor has 12 (!!!!) IR attendings, but no fellowship program. Would this be a good place to train to get optimum experience, or would somewhere like UVA be the better bet with a good clinical background and proven IR fellowship?

Thanks.

Tough to answer, and I give you props for thinking ahead.

My personal belief is that with the changing IR landscape, the hardest things to learn during your radiology training are the CLINICAL aspects and IR patient management. For example, how do you manage a patient with portal hypertension? Should you even consider doing a TIPS or any intervention? The past mindset was the IR was a technician who would do the procedure, and the future is that of an actual clinical service (consultation, recomendation).

Getting back to your question, even at a fellowship heavy program, if you have a good rapport with your fellows/attendings, if you rotate through IR in June (when the fellows are out the door), there is a good chance you can scrub in and get a head start on your technical skills, which you will hopefully master during fellowship.

 

[wheewer]

Thanks for sharing such a wealth of information on this thread. I've given great thought to pursuing IR and I'm trying to get a sense of what kind of Step 1 score it takes to match at a place like Cornell or Penn for their direct IR programs nowadays in 2015? I understand that obviously "the higher the better" and "Step 1 is important but isn't everything" but I'd appreciate any numerical input you had beyond that - thanks!

 

[TheRealDrDorian]

Thanks for sharing such a wealth of information on this thread. I've given great thought to pursuing IR and I'm trying to get a sense of what kind of Step 1 score it takes to match at a place like Cornell or Penn for their direct IR programs nowadays in 2015? I understand that obviously "the higher the better" and "Step 1 is important but isn't everything" but I'd appreciate any numerical input you had beyond that - thanks!

Very tough question to answer, especially because those programs, to my knowledge, will be recruiting for the dedicated IR Residency (former name: DIRECT pathway) this upcoming year.

That being said, to my knowledge of the programs that recruited last year (e.g. Michigan, UVA), the applications were EXTREMELY competitive. I would compare these IR Residency spots to direct vascular surgery residencies. High Step scores will definitely help, but also a dedication to the field. To help with this, I highly recommend becoming an SIR member and actively work with the SIR Resident, Fellow, & Student (RFS) Section (rfs.sirweb.org).